Relapsing polychondritis (RPC) is a systemic and, in some cases, fatal disease. Dyspnea with findings of small airway disease—even in the absence of the more commonly associated tracheobronchial abnormalities or pathognomonic clinical findings, such as saddle nose and cauliflower ear—may be presenting signs and symptoms of relapsing polychondritis. Below, we present a case demonstrating that…
Celiac Awareness Makes a Difference for Rheumatology Patients
Celiac disease and gluten sensitivity are difficult to diagnose, but they affect multiple systems and are associated with other autoimmune diseases. Lan Chen, MD, PhD, believes better testing and clearer education will be a gamechanger for celiac patients…
Ethics Forum: Righting the Wrong Diagnosis
A 54-year-old woman is establishing care in your clinic after retirement of her previous rheumatologist. Your review of her records suggests that she was diagnosed with systemic lupus erythematosus seven years ago on the basis of symptoms of body pain and fatigue, and serologic evidence of positive ANA 1:40 (speckled) and borderline anti-SSB antibody. She…
Case Review: Lupus Patient with Acute Disseminating Encephalomyelitis
Systemic lupus erythematosus (SLE) is an autoimmune-mediated rheumatic disease characterized by multisystem involvement that can cause significant morbidity and mortality. Acute disseminated encephalomyelitis (ADEM) is a rare, fulminant, autoimmune-mediated, demyelinating disease involving the white matter of the central nervous system (CNS), and is considered a manifestation of neuropsychiatric lupus. Few reported cases involve SLE and…
Physical Assessment of Chronic Fatigue Syndrome: It Just May Work
A recent U.K. study assessed the use of the Perrin technique to diagnose chronic fatigue syndrome based on five physical signs of disease. Overall, researchers found the accuracy of diagnosis by allied health professionals was highest when using tests for only two signs: tender coelic plexus and postural/mechanical disturbances of the thoracic spine…
The Diagnosis: How to Advise Newly Diagnosed RA Patients
Receiving an RA diagnosis may be emotional and difficult for patients. By engaging the patient in learning about the disease and its treatment options, as well as cultivating a communicative relationship, rheumatologists can truly help a patient take control of their health…
Rituximab Use Increasing in Treatment of Pediatric Vasculitis
According to a large cohort study of pediatric patients, rituximab use is on the rise in the treatment of children diagnosed with vasculitis. Treatment with cyclophosphamide remains common, but it’s beginning to wane. Dialysis and mechanical ventilation also remain common, the study indicates. The retrospective study of hospitalized children in the U.S. included the largest…
Does MRI Differentiate Osteoarthritis and Meniscal Tear in Knee Pain?
When a young patient arrives at a clinic complaining of knee pain with clicking or popping, a meniscal tear is often the culprit. “In young [people], there’s a pretty classic presentation of meniscal tear, with clicking and other mechanical symptoms, because the tear rubs up against different tissues,” says Jeffrey Katz, MD, MSc, a rheumatologist…
Fellows’ Forum Case Report: Progressive Weakness and Debilitation with Skin Rash
The Presentation A pale, quiet woman—her mother—wheeled the girl into my clinic. It was a blistering Florida day, and the girl was shivering. She glanced up at me when I said hello and asked her name. “Hi,” she said, giving me a broad smile. Her smile was the only broad thing about her. Her elbows…
Inside Cambodia’s Struggles with Poverty, Dearth of Trained Rheumatologists
It’s one thing for a developing country to lack physicians due to a scarcity of training. It’s quite another for such a vacuum to exist because the physicians were executed. In Cambodia in the 1970s, genocide perpetrated by the Khmer Rouge spared few of the educated class. If they were spared, chances were they lost…
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